RESPONSE OF RESISTANT IDIOPATHIC THROMBOCYTOPENIC PURPURA TO PULSED HIGH-DOSE DEXAMETHASONE THERAPY

Background. Most patients with chronic idiopathic thrombocytopenic pur pura have a response to corticosteroids or intravenous immune globulin , but improvement is often transitory. Splenectomy may provide only a short-term benefit. Because pulsed high-dose therapy with potent synth etic corticosteroids is inexpensive, well tolerated, and effective in patients with secretory B-cell neoplasms, a similar regimen was examin ed for its efficacy in patients with chronic idiopathic thrombocytopen ic purpura that was resistant to other treatments. Methods. Ten consec utively referred patients who had persistent symptomatic idiopathic th rombocytopenic purpura after undergoing at least two standard therapie s were treated with six cycles of dexamethasone (40 mg per day for 4 s equential days every 28 days). Results. All patients had increased pla telet counts (mean [+/-SD] count before treatment, 12,000+/-8200 per c ubic millimeter; after treatment, 248,000+/-130,000 per cubic millimet er). The platelet counts remained above 100,000 per cubic millimeter f or at least six months after the last cycle of treatment. There were n o serious side effects. Features of hyperadrenocorticism due to prior corticosteroid therapy resolved during treatment. The cost of the drug was approximately $100 per patient. Conclusions. Although the possibi lity of spontaneous remission and a delayed benefit from prior therapy cannot be excluded in this small group of patients, pulsed high-dose treatment with dexamethasone may provide a low-cost therapeutic option with minimal side effects in patients with refractory idiopathic thro mbocytopenic purpura.